The day you arrived though the eyes of the doula: It was mother’s day, May 11th, 2014 and I was pleasantly interrupted by a much anticipated phone call from your mom at about 6:43pm. I listened excitedly as she explained she’d been having mild and very far apart contractions, she guessed about every half hour they would come. I got myself ready because I was preparing for the good chance she would wait too long to have me call. I could tell she was going to be one of my exceptionally strong ones because of the story of how she gave birth to your brother. The way she waiting until he was ready to be born, in her circumstance, is very different from most women. She was patient and relaxed, but also brave and aware of what she deserved. My experience has taught me, this is the formula for a strong birthing woman. Your daddy was also someone I was excited to work with because of his inner strength! He taught me something I’ll never forget and I will use to help many more families; people who are responsible sometimes mistake their responsible-role for one of authority. He used this wisdom to stay confident about all the birthing decisions for you and your brother too. So, needless to say, when I got that call I was more than ready to come help with your special delivery. There was one thing I was nervous about as a result of knowing how strong your mom is. She and your dad had made multiple jokes about having the baby in the bathtub on “accident” at home. So knowing how strong she is, I was worried she would be unaware of how progressed she was and stay home too long. She really heightened my concerns when she emailed me the list of her supposedly mild and far apart contractions…they were only about 6 minutes apart! Shortly after that, your dad called me to tell me her water just broke! AGGGGGHH, I thought, and jumped in my car. I arrived at your house at 10:20pm. I was relieved at what I saw. Your mom looked relaxed enough that I knew we had time to stay home. I watched her take on a “wave” and saw how she went deep within herself and breathed slow to maintain a totally tranquil state. WOW I thought, beautiful. I was also happy to see she had taken my advice and been drinking lots of water. After some time there on the birthing ball, she jumped in the shower to clean off all of your amniotic fluid coming out. She then laid down with your brother Cole and ironically breathed slow through contractions to also help him relax and finally fall asleep. The next part was really fun. I got to meet your aunt Tabitha who came out to help cook some llapinganchos. Your dad, mom, aunt, and I all sat around, some of us also on balls. This was very special to your mom because she got to somewhat repeat the way her mom gave birth to her. There is a picture of people just hanging out and being really calm about the arrival of her when her mother was in labor. The intensity started to build here. We all breathed with her to help her remember to keep her breath slow. I put a heating pack on her back. When the contractions stopped, we laughed about how different it was in and out of them. As it got more uncomfortable, she decided she would feel more at peace in her bedroom, so we all followed her into there. We were playing a peaceful soundtrack over and over that she seemed to really like. She must have felt very safe there because her body started to make those contractions even stronger. Her senses were getting very sensitive, she had your dad change shirts twice because of the smell on them! It was pretty funny. She wasn’t interested in taking the drive and having to go through that transition to the hospital at any later stage, so she started to voice a desire to leave. It hadn’t been a very long time in labor yet, so I reminded her that her original plan to get there at a late stage might not be the case; however I was REALLY hoping I was wrong. There were some signs that I really could be wrong; she was throwing up and said she started feeling shaky. She started doing her most comforting position which was to hang from your dad’s neck and squat. Also, I had that original concern of waiting too long knowing how strong she was. So…off we went! I called the hospital on our way out at 12:36am. I was able to find parking quickly and walk in with your parents as they arrived at the hospital too. Thank Goodness your mom took my advice to keep the eye mask on, anyone that looked at her could tell she needed her space. Your dad was really brave to insist the security allow me up to the triage floor even though they normally don’t. However, once we got up there, the nurses had me wait outside the door until she was checked. I was hoping it would be fast and we’d be in and out of there anyways. I learned that her cervix was 4cm dilated, 80% effaced, and you were at a -1 station. Your mom had a little bit of bleeding there that I couldn’t be sure was okay, the nurse checked and also seemed on the fence about it. We finally made our way out of there a while later and up to the Labor and Delivery floor. When the elevator got to the 3rd floor, we had to hold the door open so she could have a contraction there. This moment was incredibly special to me personally, because your mom didn’t know it then, but she made a doctor wait for her in order for him to use the elevator. This particular doctor was the one that I worked with at my very first birth and he was the reason that first birth was an unsuccessful VBAC. That was so redemptive for me! He had to stand there and wait as he watched your strong momma chose to endure the intense and uncomfortable feeling of her contraction. I was thinking, YES you see? We birthing women are strong, we chose it, and you can’t stop us! I have to thank your mom for being the one to demonstrate that strength for me and for the mom who was kept from accomplishing her desires. THANK YOU SO MUCH TANGY! We walked into the Labor and Delivery room #316 and met our nurse, Marly. She was very kind and helpful, but she was having to be the bearer of bad news by informing your mom she would have to be on constant monitoring, not only because of her previous c-section but also because we couldn’t be sure if this bleeding would be a problem. I tried to get more information from the nurse asking her, if this was a uterine rupture (the biggest possible concern) what else would we see to be sure? Wouldn’t we see the baby’s heart rate look poor? (which is wasn’t, your heart rate looked perfect the whole time) Wouldn’t she have more pain and more bleeding then this? But the answers we got were so vague. Even though the eye mask was still on and really helping to keep your mom from all this commotion, she started to get very concerned, understandably. She spoke with the on-call doctor on the phone, but she was also very vague and told your parents they could chose to either keep laboring or have a repeat c-section. Everyone was very frustrated with this. Your mom’s fear of you and your brother missing one of their parents, as she did growing up, was manifesting. I reminded her that she hasn’t even seen a doctor to assess her situation, and to remember what a real emergency looks like. Finally she decided to get into the shower, totally against what the nurse said she was allowed to do. With the helpful support of your vocally confident dad again! There she was able to re-center herself and go back to her usual brave state. WOW, I was so proud of her! The next stage of labor was a long one! Your mom took it on like a real warrior! She had that deep inner strength that I knew she would. Her senses became extremely sensitive and she wouldn’t allow very much talking around her. Every little smell would bother her. And she also stopped wanting anyone to touch her. I was so proud of her, but I had to practice sitting on my hands so to speak. I really wanted to help her more. Your dad did too as he reminded her, “I really want to hug you right now, just so you know.” She even switched robes 3 times! She said, “get me the gray one, no the other gray one, NO THE OTHER GRAY ONE.” That was pretty funny too. I couldn’t ever come close to being offended by her snappy words because her ability to know what she needed and ask for it takes an immense amount of strength. Most laboring women don’t do that, they just throw in the towel and ask for an epidural. Not your mom! In fact, she never seemed to go through that highest level of pain called “transition.” Rather, she just kept doing what she knew worked for her. I learned later from her that she had a very elaborate vision she would focus on through each contraction, of which I’m sure she’ll describe to you one day. She is truly made to birth! She has the best instincts and she really listens to them! I could only compare her strength to one other women I’ve seen giving birth for the 4th time, but in a way, this was her first time! Your dad was such a trooper too. He continued to be there for her just how she needed, no judgment, and no throwing in the towel for him either. No matter how sore his neck and legs must have been! At 6:45am I noticed her body start to bare down a little bit in the middle of contractions. We talked about how getting checked might be a good idea to know whether she should or shouldn’t start pushing. And thank God we got a new nurse who happened to be the best at that hospital. Her name was Tommy Lynn. We learned she was 8cm, 100% effaced, and you were at a 0 station. I’m glad we knew because she had to hold off from pushing for three more hours until she was checked again and learned she was 10cm. We tried different types of positions for pushing. But after two hours something strange seemed to be happening. We eventually learned that her cervix was swollen. She must have been so exhausted! She didn’t show it at all, but I felt so bad for how hard she had to work. Finally her doctor, Dr. Timothy Riley came in and pushed that cervix up over your head. NOW pushing was finally more effective and we really started to see you make your way out. At 12:57pm on May 12th (the exact day your mom predicted) you were born! You went right to your mother’s arms. There were a few surprises that needed addressing, your mom needed to be repaired quickly and so your dad stayed with you. You also needed some help breathing so your dad followed you the NICU. We learned that you weighed 9lbs 1oz and were 20 in long. Your mom was excited to hold you but she was very grateful for her skilled doctor taking care of her and the nurses taking care of you. Thank goodness again for your dad’s ability to stand up for what’s right. He demanded to be with you even when they said no. In the recovery room, we got some info from your dad that you were stable. After everything she had been through, her love for you was what got her through all of that. What an amazingly loving and strong momma you have Kai! You are SO BLESSED to be a part of a family who puts their priorities in what is loving and what is best for you and your brother! I am forever grateful to witness parenting at its greatest. Thank you so much to your whole family for allowing me to be a part. You are a miracle Kai! Your mom was able to snuggle you and nurse you in the NICU. You were always surrounded by love. Lots of love your way continued! Your forever birth doula,
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Heather's own words:
I am so fulfilled, so empowered, so proud, so thankful and so blessed that we were able to have our baby in the comfort of our home. I wasn't sure I was in labour, and was hesitant to have my Doula and Midwife come over. I began having surges (contractions) in the swimming pool at around 6:30 pm, and I was certain I just ate something funny because surges were immediately about 15 minutes apart :0. At around 9:30 ish, I was still uncertain and began messaging my Doula and "on... call Midwife" (whom I had not previously met; my own Midwife was out of town for the evening...). I had asked my Doula to come over, just incase, at 10:00. I threw up a little bit. She had arrived by 11:00. After i threw up a little more, I had asked the Midwife to come. I remember my own Midwife telling me something about vomiting, and it made me certain, that YES MY BABY IS COMING. Before I threw up for the second time, I was in this state of mind, still not sure if my baby was coming or if I was just over exaggerating. The Midwife arrived by 11:45 ish. I just wanted to be left alone, in my bedroom, where I swayed back and forth in front of the fan. I was so hot. Again, I threw up, and this time my bag of waters broke at the same time. It sounded like a water balloon hit the floor :0. Shortly after, the Midwife "checked me" and told me something along the lines of "when your body feels like it wants to push, let it". I did not think I was fully open and asked her "push what"? .... And shortly after that, I got into the birth tub, where I began pushing/trying to breathe baby down. I consciously tried to let him open me slowly and spent about 35 minutes doing this. The last "pushes" were spent on the couch so that baby could be better accommodated (I couldn't maneuver a good leg lift in the tub). Troy Aeric was born at 1:40 am, on Wednesday August 31, weighing 9 lbs., 9 oz. and measuring 21 inches. The entire time, Alexander was asleep in my bedroom. He woke up about an hour or so after the birth. He was able to see the placenta and where the baby lived. I am so thankful for all of the support with the fundraiser, generous friends and coworkers, and Ginger Lee Doula for letting me do my thing (and for cooking me the mac and cheese I had requested after delivery ;) We did not take many photos during, because I just wanted to be left alone ;). The entire experience was completely new to me because I had NO sign of labour with my first pregnancy, and was medically induced at 41 weeks, where I had delivered in a hospital. I am so pleased, overall. A healthy pregnancy, healthy baby, and a happy Brother. Hello Lavin, I am your doula and I was also your brother’s doula. My name is Karen. This is the story of your birth, as I was honored to witness it. On Wednesday August 24th, 2016 Danica sent me a text that said “I am starting to get consistent contractions.” Apparently this started at about 7am. So I called her and learned that they were ironically close, yet short and seemingly feeble compared to what she remembered her last birth being like. I learned that they might be closer than expected for the beginning of labor because she had created some “friction” with your Dad that morning to add to those sensations. Plus, I already knew that she was trying some things to get your birth going like pumping and clary sage. I assured her that it would be soon and probably she just jump-started the process. But just in case, she should drink lots of water and maybe even try the bath to slow it down if this was really signs of dehydration. I told her I would continue to check in with her. I lived further away now compared to when your brother was born, so I wanted to make sure I was closer if need be. Even though her “surges” (contractions) were close, they were short and she stated that she was going to try and nap, so I was very prepared but not rushing down. Later on I learned that she wasn’t really napping, rather, she was crying out to God at her parent’s house, hugging pillows, and worshiping. She felt like she was really getting into her birthing body, like all mammals, being alone and going deep mentally. And she remembered her friend Mina’s encouragement to focus on “Euphoria.” This was where Kamden was left with your grandparents for the rest of the birth. I called your Dad because I knew that sometimes your mom can be too kind and not wish me to come even though I should. I asked him to tell me what he thought once he saw her. He was on his way to pick her up from her parent’s house. At this time I was at my daughter’s school, trying to let her finish lunch before checking her out and taking both of my girls to their grandparents on the way to the birth. At 12:15 I planned to check her out whether or not Danica said she wanted me, simply because if it’d been continuing on that long since the morning, surely, it would pick up soon. EXACTLY at 12:15 your Dad texted me that she asked me to come. I flew down the freeway and met their grandma right off an exit to drop the girls off. I had to pee the entire time and that was good motivation to go fast too. Drew described the surges as stronger and longer only beginning right before this. So we wouldn’t have categorized her active labor to officially start until around 12pm. After I dropped the girls off, I told Drew how far away I was in surges. “I’m only 5-6 surges away!” I texted. Which is about twenty minutes. He said that Danica was thinking it was time to go to the hospital soon. Maybe she was worried about getting to the hospital in time for antibiotics being GBS positive? I thought. I reminded your Dad that as long as your water was intact, there was no exposure to any bacteria. When I arrived to your house it was 1:20pm. Drew opened the gate for me and he said that the surges were really strong and close. I figured, okay, maybe it was going fast but I was glad to be there to make sure. I walked past Rosa, the cleaning lady who was there the whole time. When I saw Danica, I began to wonder even more. She was leaning over their bed and had worship music playing. Her legs were crossed at her calves. I giggled quietly because it reminded me of what she would do during your brother’s birth. I pointed to that so your Dad could see. I wondered if maybe she was just having trouble embracing the pressure and your Dad and I tried to help her release her muscles more. We rubbed her back and encouraged her to try another position. But then she said that she had just went to the restroom and wiped and felt something inside (about two inches up she said). I learned later that was about 15 minutes before I’d arrived. We discussed how maybe that was a bulging bag of water like last time. There was no sign of a natural expulsive reflux at all. A bulging bag would make sense because when women squeeze their muscles in their lower half, sort of tensing with the pressure, the bag of water will often bulge out. There was no other sign of progress, no bloody show, no urge to push, no shaking. She did vomit once right before I got there though. So we prayed for God’s perfect timing, and I asked her to use her discernment (not any thoughts prompted by fear) to help us make a good decision. She said she didn’t think we were going to make it and we should leave. So then I asked Drew to prepare the car and I asked her to go back to the toilet and feel again. It would be good to go to the bathroom anyways before leaving and this gave Drew a chance to get the car ready. So I stood outside the bathroom door, halfway looking in to make sure she was okay. This is where everything went from speedy to lightning fast. I had just texted her friend (a mutual friend of mine too, Jessica) that I didn’t think we were going to make it. Danica then exclaimed, “Karen I feel his head. We’re not going to make it are we.” I knew we weren’t then for sure, but I wanted to keep her calm, so I said “That’s okay, I’ll see if I can get this bath ready in time.” But when I reached towards the bath, she completely calmly stated, “I’m crowning.” I looked and responded equally as steadily, “yes you are, please get off the toilet, here’s a towel, get on your hands and knees, we don’t want a baby in the toilet.” She had barely felt only a tiny bit pushy. As she came off the toilet, she squatted. We estimate this time to be 1:46pm. I popped my head out the bathroom and yelled to Drew “DREW CALL 911 AND GET IN HERE.” He came immediately, and I calmed my voice back down and said, “You can come help receive your baby, get behind Danica.” I don’t think he spoke much, just did exactly what I said, which was perfect! He handed me the phone where the 911 operator was already there. Your head came out as your mom squatted, and then she moved to her hands and knees. When he saw that the head was out but the sac remained covering your face he was confused and reluctantly spoke, “is he okay?” I reminded him that it was totally fine because you didn’t need to breathe yet. I said, “Just wait for the next surge and watch, his head will turn and the shoulders will come out.” We estimate at 1:47 or 1:48pm the rest of your body slipped right out. And slippery it was! Your Dad received you so well with both hands. You were in his arms. Your sac broke around your midsection while you were on the way out, so I explained how Drew could just lift it right over your head. I remember so much of this time being between myself and your Dad. I assume Danica was just with Jesus, because she was completely calm and birthed you blissfully. Drew and I explained to her how she needed to lift her right leg over your cord. And she did confidently and received you in her arms immediately. I helped get you more on your tummy for skin to skin, as I halfheartedly answered the 911 operator’s questions. The 911 operator was making me laugh because of the ridiculous things she was saying, like go get a shoe string for the cord. I responded, “No I think we’ll let baby get all his oxygen from the cord.” She said someone was on their way so I hung up and tended to Danica. I got her some pillows to rest on and your Dad got more towels to keep you warm. Everything was perfect! You were breathing and crying just fine. Your color and movement was great too. You actually stopped crying quickly and just peacefully rested on your mom. I checked to make sure her bleeding wasn’t too much and it was okay at this time. I explained to your parents how the paramedic team would be asking a lot of questions and might rush us, but to take their time and make sure they speak up for what they want, like skin to skin for the ride there. I also took this time to try and help Danica get you latched, but you seemed to be less than ready. Understandably, because you were probably shocked how fast it was too! We tried to do some manual nipple stimulation instead to help the placenta deliver. The paramedics who came work for the same company as my husband and I knew they have strict rules against skin to skin for the ambulance transport, so your Dad and I both vocalized that desire clearly. We know their names were Steve, Kenny, and Heidi (among others from the fire department), so they deserve a big thank you! They did say some pretty comical things though, and I could tell that the main paramedic who was helping us was very nervous. So I answered all his questions and explained some things for him. Like how he thought the baby needed to remain lower than the placenta, and how he thought you had to aspirate the baby even though you were already breathing just fine, and how he thought we should wipe off your vernix (your God-given antibacterial protectant). Where it was especially funny was when I learned that it had been 30 minutes since your birth and the placenta still wasn’t delivered, so I explained to all 6 emergency medical professionals that we should try and see if Danica can push it out. They all agreed, but they all turned their heads and left the bathroom. I asked for some gloves and they were happy to give me whatever I needed so they didn’t have to do it. I don’t know if I’ll ever stop laughing at that memory. I tried to help Danica push your placenta out, but it wouldn’t come. We tried a few different positions and I worried that without any medication to stop bleeding it would be unsafe to keep her there any longer. So the paramedics got the gurney ready. Your Dad got Danica her big black robe that said “Rock Star.” As your mom laid down, your Dad held you skin to skin on himself. Drew, once again, spoke to the paramedics explaining that they would keep you on your mom for the ride. And thank God they obliged! Your parents were all smiles and realized some really amazing things about your birth. Like the fact that the rugs in the bathroom that were probably ruined, already had replacements because Amazon.com accidently sent Danica 4 instead of 2! And the fact that you were born en caul (in your sac) which meant that you literally had not one bit of exposure to GBS. Although GBS illness in babies is very rare (3 in 10,000), because your brother was in the NICU after his birth, your parents were praying for that peace of mind. Unfortunately, the one thing that was not ideal was that Danica lost a lot of blood. When they arrived at Sharp Grossmont, they calculated about 1500ccs. Your mom actually passed out! Poor Drew, what a scary moment that must have been. That was a greater blood loss than the nurse or myself has ever seen. So thank God she came to quickly and was fine after that. She didn’t need a blood transfusion, and we all found food for her to hopefully build her strength back up. When I found your parents in room 16, they were with a darling nurse Sara. She was a home birther herself! She was so nice and accommodating for your parents’ wishes. Dr.Vu (her main doctor) came in later to remind Danica that he said not to have the baby at home, haha! All the grandparents came with wide eyes and amazement at what just happened. Kamden, saw you for the first time and he seemed interested, but also interested in snacks from Grandma. He started typing on the computer in the room, so maybe he was trying to help with your records. Later on, your parents learned that the second GBS test Danica did was in fact positive, so this was further evidence that your birth was truly an answer to prayer. Who knows, if we had made it to the hospital, it might have gone too fast and a different doctor might have routinely broken your water as they often do. Although, the doctor who was there, Dr. Fulford, did seem to be very helpful and kind delivering your placenta. By the time I left you, you were nursing like a champ. For a long time actually and very strong! I drove home calling my midwife friend and incoherently leaving a message about how beautiful the birth was. But as I spoke I realized something even more miraculous. You are Lavin Zachary, Zachary after your Dad’s best friend who’s life was ended much shorter than expected only a year prior. God allowed your Dad to redeem life, by recieving the miracle of life as profoundly marvelous as it could possibly be – right into his hands. And as I drove away, your parents realized that your birth weight was the late Zachary’s birth DAY! 8-12 (you were 8lbs 12 ounces). To say that heaven rained down on your birth is an understatement. I always knew I would hold your mom Danica in a special place in my heart, but now this birth is also going to be the most unforgettable and truly extraordinary experience I will cherish forever. Thank you again, for allowing me into your family to help with your parent’s journey to birthing. I am in awe at God’s grace and favor over your family. I believe that you and your brother will grow up with strong parents who teach you to trust in the Lord, because they have already lived through the ups and downs with faith. You were destined for greatness Lavin, I can’t wait to see you walk out your God-given purpose. Lavin Zachary 8lbs 12oz 14inch head (no tearing for mom!) 21inches long Born en caul at home this is a photo of myself and my little Mikayla. Her sign says "I'm Improving Birth because I had a doula. This picture was taken at my first Improving Birth Rally in 2013. Last year Mikayla attended her third Improving Birth Rally with me and this picture was taken...
Intro:
I’ve only attended about 70 births as a birth doula, which means I’ve helped about 17 women face the decision of accepting or declining antibiotics for being GBS positive. For some, it’s an easy decision. It’s preventative, so why not? For others, the consideration of baby’s gut flora comes into play and these parents want to learn about how to make a safe decision all around. One couple of parents who were my clients are professionals in the health and exercise industry. They looked at the risks and ultimately decided, unless her water was released for a prolonged amount of time, or there were signs of infection, they would forgo the antibiotics. Thankfully her birth was a beautiful challenge met with bravery and she successfully delivered her big boy less than a few hours after her water released. Unfortunately, her care provider was rushed during the delivery and pulled a lot on the baby’s neck. When the baby came out, he didn’t seem to take to breathing well. He grunted a lot and it was the first time ever I could not get a baby to latch. I was so confused about the baby’s lack of interest in feeding, but blamed myself and decided to investigate outside of the parent’s vulnerable eyes. The baby was admitted to the NICU for GBS induced phenomena within an hour or so of his birth. No, I thought. There’s no way! He was not exposed to the birth canal for long enough to develop an infection that quickly! I called a chiropractor, a midwife, and a lactation consultant. I explained what I saw and put all of their wisdom together. I learned that the majority of the remaining fluid in a baby’s lungs is pushed out as they take their first few breaths. I learned that a vagus nerve injury is very possible when there is aggressive neck pulling. I learned that the vagus nerve is directly related to proper breathing. That week the baby spent in the NICU simply to finish his round of antibiotics was the most frustrating thing. But I can’t even begin to describe how frustrating it was for his parents. Not only were they met with the challenge of maintaining their beliefs on avoiding formula, getting skin to skin time, etc… they were also being told it was their fault for not taking antibiotics in labor. This was the beginning of my obsession with GBS protocol. I could not let this scapegoat diagnosis turn these wonderful, smart, protective parents into doubt and fear. We all learned something very important and that baby IS an overcomer just like his parents. Discussion: Welcome to my latest obsession in maternity care! My name is Karen Brann and I am a certified birth doula, a certified childbirth educator, and a certified lactation educator/counselor. I don’t really know how I ended up with all those titles after my name other than the fact that I completely fell into this passionate pursuit. The seemingly endless pursuit of returning birth a postpartum care to an evidence based, calm, and safe place. I’ve learned a lot about the difference between the midwifery model of care and that of the OBGYNs. I realize that these are two different worlds. You could almost sum up that difference with all things expectant management vs all things controlled management. The last thing I dug up and pulled apart was third stage management, and let’s just say, yanking on a cord and ripping off blood vessels attached to a uterine wall is NOT a proven method to lessen postpartum hemorrhage. It’s not, and that’s obvious. Anyways, back to the rabbit hole at hand; GBS positive moms and maternity care protocol. I’m about to go way deeper than you ever thought possible on the topic of what happens in labor when you test positive from a vaginal and anal swab for Group Beta Strep Bacteria. This is NOT about testing positive in your urine. I am not going to pick apart the protocol or use of antibiotics for women who test positive for GBS in their urine as those risks are completely different. This IS about the one million + women per year in America who are being given prophylactic antibiotics in labor. I believe many of them unnecessarily treated. The prevention method is there to lower the risk of babies who develop GBS disease. Either early-onset (less than 7 days old) or late-onset (greater than 7 days old). 80% of cases are early-onset. For late-onset of GBS, there is evidence that suggests it can be acquired through community sources and through the hospital itself (“nosocomial transmission”). GBS disease has been deemed the leading bacterial infection associated with illness and death among newborns in the United States since its emergence in the 1970s. The estimated fatality rate for newborns with GBS disease is about 6%. Unfortunately, my research has revealed that 50% of the babies who developed sepsis did have a GBS positive mother who RECIEVED antibiotics in labor. Also, I have read that there is a found correlation with sepsis and E.coli in these babies. In other words, clean eating may be a helpful way to lower risks. Preterm labor and prolonged rupture of membranes (more than 12 hours) are the greatest link to early-onset GBS disease; those variables increase the likelihood of early-onset neonatal GBS by 8 times more than those without those factors who simply tested positive for GBS from a vaginal and rectal swab. Even if you test negative for GBS during pregnancy, studies show a .0004% chance of neonatal GBS disease. Furthermore, it’s only a .0032% chance of baby developing GBS disease when testing positive even if we combine the rectal and vaginal results. For high risk factors, (prolonged water release and premature labor) it’s a .0076% chance. The emergence of this bacteria has been connected to a change in milk processing at dairy farms. The gastrointestinal tract is the most likely human reservoir for GBS. Culturing specimens from both the rectum and vagina increases the likelihood of a positive test from 5% to 27%. Having a heavy surface colonization increases risk factors; however, there is no communication between provider and patient about how much of the bacteria is being found. I theorize this has something to do with the fact that the levels of GBS bacteria can go up and down with changes in diet. I also theorize this is why it’s more likely to test positively only rectally (41%-50% more likely) and not vaginally. Studies show that if the bacteria is only found rectally, it’s a lesser risk for baby; however, those results are not discussed between providers and patients even though statistically speaking that’s a possibility of up to twice the necessary antibiotic use in labor. These possible unnecessary treatments should be considered for the 10 babies a year who die from the antibiotics themselves due to allergic reactions. Why so many? GBS is a very common bacteria to test positively for. We never know, without doing a test on the spot, if a women is still considered positive at the time of delivery. However, it’s very common to test positive during her pregnancy. It’s a positive test for about a 1 in every 4 women in America. The amount of positive tests, are the amount of women who will be told to take antibiotics in labor. That is because a meeting of experts from the CDC, ACOG, and the AAP in 1995 (that’s over 20 years ago) decided the standards. From that day on, the standard remains that all women who test positive from one swab at 35-36 weeks will be given antibiotics in labor regardless of any and all low risk factors. AND if they don’t know the results of the test, its presumed positive and antibiotics are given then too. I decided to read all of the studies that contributed to that decision, yes, all of them. Probably the most frustrating thing I learned was that they did not follow through on implementing a test given in labor because it was decided it wasn’t worth the cost. There would have to be a working lab open 24hours a day and 7 days a week. Even though that would statistically save 23% from any need to take antibiotics in labor. Furthermore, they did a lot of trials on intrapartum testing, and they found that 8.9% of women who were positive during labor, were tested negative during pregnancy! Hello! Aren’t we missing something here?! To make matters worse, the other reason for not having a rapid result test in labor is the common belief in the labor and delivery room that women can’t be trusted to make their own informed decisions. The concern with the intrapartum test is, “the complexity of communicating risk information regarding GBS to women during pregnancy.” –CDC In reality, simply the fact that some women chose not to take the antibiotics during trials was mentioned as a concern. Sickening, I know. I suppose then the discussion of how to lower the GBS colonization with diet changes would also be too much responsibility for patients to understand as well? If you read my introduction, you know that I also theorize another problem. Could early-onset GBS disease be, in part, a scapegoat for other birth-related influences? Since GBS disease is characterized as pneumonia, and pneumonia is by definition retained fluid in the lungs, lets look at what else can cause this. If a vagus nerve injury could cause poor breathing thus fluid retention, what other connections could we be missing? If pneumonia is described as fluid in the lungs, it makes sense that 25% of cases of neonatal GBS disease occurs in premature infants. Was that GBS disease? Or was that a baby who didn’t get the chance to live in utero during the time that hormonal changes push out some of the fluid in their lungs? This connection also provides an explanation for the fact that low-birth weight babies are also at a higher risk. In addition to this potential scapegoat, I can also see a possible issue with diagnosis in that greater risks have been documented for vaginal exams, internal monitoring, and membrane rupture for more than 12 hours. All of these things promote bacteria, especially vaginally exams which we know are the leading cause of corioamniostitis (the infection they talk about when they say your water has been released for too long). Lastly, the fact that women in labor who simply have an elevated temperature are being presumptuously diagnosed with an infection is jumping right over the fact that 70% of women have epidurals and we know epidurals cause fevers. It’s all one complicated mess of variables. GBS is the easiest thing to point the finger at for all of these variables. In case you’re wondering, what else raises and lowers the risk of neonatal GBS disease, let’s talk about some more information. The chance is about 25% for all pregnant women that they will test positively in pregnancy. As discussed earlier, much greater for premature births and prolonged water release. It is also more likely for women who are less than 20 years old. It is more likely for women of black race. It is less likely if for Hispanic women. It’s more likely if you’ve tested positive in the past, and more likely if a previous delivery has resulted in early-onset GBS disease. It’s also more likely for babies born via belly (c-sections). It’s less likely for the fourth or subsequent babies. In case you’re wondering, can we treat women with antibiotics during pregnancy instead of in labor? Sorry, no. 70% of women who were colonized and treated in their third trimester of pregnancy were still positive at delivery. Conclusion (AKA SKIP TO HERE IF YOU'RE TOO BUSY) : So let’s sum up some of this surprising information. Over one million women per year in America are being treated with antibiotic in labor for testing positively for GBS during their pregnancy. With the biggest risk factors included (premature birth and prolonged water release for more than 12 hours), the chance of a baby developing early-onset neonatal disease is .0076%. It’s possible that at minimum 41% of these cases of moms being treated, could be avoided if providers communicated the fact that they only tested positively rectally, which lessens risk for baby. It’s possible that 23% of these cases of moms being treated could also be avoided if there was a rapid results test. Frighteningly, there are cases missed because there isn’t a rapid results test. Even more frighteningly, there isn’t one because of the cost and also because women aren’t considered responsible enough to make their own informed decisions when they know all the risks. Probably the most shocking thing, is that 50% of the cases of sepsis for neonatal early-onset GBS disease happened even when the mother was treated with antibiotics in labor. Frustratingly, the characteristic of pneumonia being a description of early-onset GBS is very possibly a reason for a scapegoat diagnosis. So what will we do with all of these facts? My goal in uncovering this information is not to convince women to decline antibiotics in labor. It is however, to give them all the facts so they can make their own informed decisions. Also, I’d like to encourage the patient population to demand a rapid results test. I am not a doctor, I’m not a medical professional of any kind. I’m not even a medical student writing a paper for a class. I’m a birth doula and a childbirth educator. I’m an advocate for women. I spent my own time and my own recourses to research and uncover this information simply because my job means that much to me. If you’d like to check some of my claims, feel free to check out these sources listed below. You will not find clear cut statistics like I stated. There was some calculating involved by looking at the numbers stated in the various studies. Do your own research and make your own decisions. If there’s one thing that I shouldn’t have to prove it’s that women deserve to be treated like capable parents, and parents deserve to make informed decisions for their bodies, their births, and their babies. http://www.cdc.gov/mmwr/preview/mmwrhtml/00043277.htm THE JOURNAL OF INFECTIOUS DISEASES • VOL. 148, NO.5. NOVEMBER 1983 © 1983by The University of Chicago. All rights reserved. 0022-1899/83/4805-0004$00.81 Selective Intrapartum Chemoprophylaxis of Neonatal Group B Streptococcal Early-Onset Disease. II. Predictive Value of Prenatal Cultures Kenneth M. Boyer, Cecile A. Gadzala, Peggy D. Kelly, Laurence I. Burd, and Samuel P. Gotoff THE JOURNAL OF INFECTIOUS DISEASES • VOL. 145, NO.6. JUNE 1982 © 1982 by The University of Chicago. All rights reserved. 0022-1899/82/4506-0002$00.75 Anorectal and Vaginal Carriage of Group B Streptococci During Pregnancy Hugh C. Dillon, Jr., Elizabeth Gray, Mary Ann Pass, and Barry M. Gray
It was mother’s day, May 11th, 2014 and I was pleasantly interrupted by a much anticipated phone call from your mom at about 6:43pm. I listened excitedly as she explained she’d been having mild and very far apart contractions, she guessed about every half hour they would come. I got myself ready because I was preparing for the good chance she would wait too long to have me call. I could tell she was going to be one of my exceptionally strong ones because of the story of how she gave birth to your brother. The way she waiting until he was ready to be born, in her circumstance, is very different from most women. She was patient and relaxed, but also brave and aware of what she deserved. My experience has taught me, this is the formula for a strong birthing woman. Your daddy was also someone I was excited to work with because of his inner strength! He taught me something I’ll never forget and I will use to help many more families; people who are responsible sometimes mistake their responsible-role for one of authority. He used this wisdom to stay confident about all the birthing decisions for you and your brother too. So, needless to say, when I got that call I was more than ready to come help with your special delivery. There was one thing I was nervous about as a result of knowing how strong your mom is. She and your dad had made multiple jokes about having the baby in the bathtub on “accident” at home. So knowing how strong she is, I was worried she would be unaware of how progressed she was and stay home too long. She really heightened my concerns when she emailed me the list of her supposedly mild and far apart contractions…they were only about 6 minutes apart! Shortly after that, your dad called me to tell me her water just broke! AGGGGGHH, I thought, and jumped in my car. I arrived at your house at 10:20pm. I was relieved at what I saw. Your mom looked relaxed enough that I knew we had time to stay home. I watched her take on a “wave” and saw how she went deep within herself and breathed slow to maintain a totally tranquil state. WOW I thought, beautiful. I was also happy to see she had taken my advice and been drinking lots of water. After some time there on the birthing ball, she jumped in the shower to clean off all of your amniotic fluid coming out. She then laid down with your brother Cole and ironically breathed slow through contractions to also help him relax and finally fall asleep. The next part was really fun. I got to meet your aunt Tabitha who came out to help cook some llapinganchos. Your dad, mom, aunt, and I all sat around, some of us also on balls. This was very special to your mom because she got to somewhat repeat the way her mom gave birth to her. There is a picture of people just hanging out and being really calm about the arrival of her when her mother was in labor. The intensity started to build here. We all breathed with her to help her remember to keep her breath slow. I put a heating pack on her back. When the contractions stopped, we laughed about how different it was in and out of them. As it got more uncomfortable, she decided she would feel more at peace in her bedroom, so we all followed her into there. We were playing a peaceful soundtrack over and over that she seemed to really like. She must have felt very safe there because her body started to make those contractions even stronger. Her senses were getting very sensitive, she had your dad change shirts twice because of the smell on them! It was pretty funny. She wasn’t interested in taking the drive and having to go through that transition to the hospital at any later stage, so she started to voice a desire to leave. It hadn’t been a very long time in labor yet, so I reminded her that her original plan to get there at a late stage might not be the case; however I was REALLY hoping I was wrong. There were some signs that I really could be wrong; she was throwing up and said she started feeling shaky. She started doing her most comforting position which was to hang from your dad’s neck and squat. Also, I had that original concern of waiting too long knowing how strong she was. So…off we went! I called the hospital on our way out at 12:36am. I was able to find parking quickly and walk in with your parents as they arrived at the hospital too. Thank Goodness your mom took my advice to keep the eye mask on, anyone that looked at her could tell she needed her space. Your dad was really brave to insist the security allow me up to the triage floor even though they normally don’t. However, once we got up there, the nurses had me wait outside the door until she was checked. I was hoping it would be fast and we’d be in and out of there anyways. I learned that her cervix was 4cm dilated, 80% effaced, and you were at a -1 station. Your mom had a little bit of bleeding there that I couldn’t be sure was okay, the nurse checked and also seemed on the fence about it. We finally made our way out of there a while later and up to the Labor and Delivery floor. When the elevator got to the 3rd floor, we had to hold the door open so she could have a contraction there. This moment was incredibly special to me personally, because your mom didn’t know it then, but she made a doctor wait for her in order for him to use the elevator. This particular doctor was the one that I worked with at my very first birth and he was the reason that first birth was an unsuccessful VBAC. That was so redemptive for me! He had to stand there and wait as he watched your strong momma chose to endure the intense and uncomfortable feeling of her contraction. I was thinking, YES you see? We birthing women are strong, we chose it, and you can’t stop us! I have to thank your mom for being the one to demonstrate that strength for me and for the mom who was kept from accomplishing her desires. THANK YOU SO MUCH TANGY! We walked into the Labor and Delivery room #316 and met our nurse, Marly. She was very kind and helpful, but she was having to be the bearer of bad news by informing your mom she would have to be on constant monitoring, not only because of her previous c-section but also because we couldn’t be sure if this bleeding would be a problem. I tried to get more information from the nurse asking her, if this was a uterine rupture (the biggest possible concern) what else would we see to be sure? Wouldn’t we see the baby’s heart rate look poor? (which is wasn’t, your heart rate looked perfect the whole time) Wouldn’t she have more pain and more bleeding then this? But the answers we got were so vague. Even though the eye mask was still on and really helping to keep your mom from all this commotion, she started to get very concerned, understandably. She spoke with the on-call doctor on the phone, but she was also very vague and told your parents they could chose to either keep laboring or have a repeat c-section. Everyone was very frustrated with this. Your mom’s fear of you and your brother missing one of their parents, as she did growing up, was manifesting. I reminded her that she hasn’t even seen a doctor to assess her situation, and to remember what a real emergency looks like. Finally she decided to get into the shower, totally against what the nurse said she was allowed to do. With the helpful support of your vocally confident dad again! There she was able to re-center herself and go back to her usual brave state. WOW, I was so proud of her! The next stage of labor was a long one! Your mom took it on like a real warrior! She had that deep inner strength that I knew she would. Her senses became extremely sensitive and she wouldn’t allow very much talking around her. Every little smell would bother her. And she also stopped wanting anyone to touch her. I was so proud of her, but I had to practice sitting on my hands so to speak. I really wanted to help her more. Your dad did too as he reminded her, “I really want to hug you right now, just so you know.” She even switched robes 3 times! She said, “get me the gray one, no the other gray one, NO THE OTHER GRAY ONE.” That was pretty funny too. I couldn’t ever come close to being offended by her snappy words because her ability to know what she needed and ask for it takes an immense amount of strength. Most laboring women don’t do that, they just throw in the towel and ask for an epidural. Not your mom! In fact, she never seemed to go through that highest level of pain called “transition.” Rather, she just kept doing what she knew worked for her. I learned later from her that she had a very elaborate vision she would focus on through each contraction, of which I’m sure she’ll describe to you one day. She is truly made to birth! She has the best instincts and she really listens to them! I could only compare her strength to one other women I’ve seen giving birth for the 4th time, but in a way, this was her first time! Your dad was such a trooper too. He continued to be there for her just how she needed, no judgment, and no throwing in the towel for him either. No matter how sore his neck and legs must have been! At 6:45am I noticed her body start to bare down a little bit in the middle of contractions. We talked about how getting checked might be a good idea to know whether she should or shouldn’t start pushing. And thank God we got a new nurse who happened to be the best at that hospital. Her name was Tommy Lynn. We learned she was 8cm, 100% effaced, and you were at a 0 station. I’m glad we knew because she had to hold off from pushing for three more hours until she was checked again and learned she was 10cm. We tried different types of positions for pushing. But after two hours something strange seemed to be happening. We eventually learned that her cervix was swollen. She must have been so exhausted! She didn’t show it at all, but I felt so bad for how hard she had to work. Finally her doctor, Dr. Timothy Riley came in and pushed that cervix up over your head. NOW pushing was finally more effective and we really started to see you make your way out. At 12:57pm on May 12th (the exact day your mom predicted) you were born! You went right to your mother’s arms. There were a few surprises that needed addressing, your mom needed to be repaired quickly and so your dad stayed with you. You also needed some help breathing so your dad followed you the NICU. We learned that you weighed 9lbs 1oz and were 20 in long. Your mom was excited to hold you but she was very grateful for her skilled doctor taking care of her and the nurses taking care of you. Thank goodness again for your dad’s ability to stand up for what’s right. He demanded to be with you even when they said no. In the recovery room, we got some info from your dad that you were stable. After everything she had been through, her love for you was what got her through all of that. What an amazingly loving and strong momma you have Kai! You are SO BLESSED to be a part of a family who puts their priorities in what is loving and what is best for you and your brother! I am forever grateful to witness parenting at its greatest. Thank you so much to your whole family for allowing me to be a part. You are a miracle Kai! Your mom was able to snuggle you and nurse you in the NICU. You were always surrounded by love. Lots of love your way continued! Your forever birth doula, Karen Sousa It just occurred to me that it's almost April and my next HypnoBirthing series begins within the second week of that month. And then it occurred to me that those series will end at the beginning of May. And then I realized that I cannot begin another series directly after that because it will conflict with my wedding! So what does that mean?! I need to make sure all of those who were waiting until May or June to take this awesome natural childbirth class, sign up now! How does time fly so fast? Thankfully there are three different options to meet everyone's demanding schedules. Monday evening, Friday evening, and Saturdays (time to be decided). Here's to the next-next series being taught by Karen Brann, instead of Karen Sousa! WHOA! Surprise, surprise! Audrey, knowledge of your birthday came a much different way than expected. Your mom was working so hard to be patient as she waited and waited for signs of labor to start. Your “guess date” had already passed almost a week before and she headed to a regular doctor’s appointment. Your Dad and I went with her for moral support because being extra-pregnant is not easy for anyone. I was also interested in going because I was curious about some leaking-issues she mentioned a few days prior. No one would have expected that those few, mild, come-and-go, leaking experiences would turn out to be your amniotic fluid exposed! Dr.Cobb delivered the news gently then left the room to let it settle in. His advice was to head to the hospital immediately to start Pitocin and make sure you get here quickly. No one wanted you to be in danger staying inside your Mommy because of the rising risk of infection as time went on. What a cluster of emotional moments in that small doctor’s office room. Your mom had spent more time being prepared and educated about what to expect then the vast majority of American women; however, this news still came as a shock. Thankfully, she had also prepared for unexpected moments in the process; so, she gathered her thoughts and chose to remain calm and faithful. She and your Dad both voiced how proud they were that she didn’t cry then. They were very careful to think before acting, but ultimately they knew they could trust their doctor, so off to the hospital they went. They took my advice to stop and get some food first. Then they arrived at Pomerado Hospital in Poway, California at about 5:00pm on March third 2014. I gave your parents a quick pep talk and then up to the fifth floor we went. They were checked into room 510 pretty quickly. Your mom’s immense preparation and organization started to prove its pay off. She already had her hospital bag, birth plan, pictures to put over the clocks, and hypnobirthing door sign with her! Plus, she had coincidently had a nice shower before leaving her house. It’s not as common to see a lot of action quickly in these special situations so once they settled in the room, I said goodbye. I was believing and hoping to get called back quickly once active labor began. The nurse at the time was Tanya. I gave her my number just in case. She seemed like good and caring hands to leave your mom and dad in. Unfortunately her shift ended just a few hours later L . At about 12am my concerned heart woke me up so I checked my phone. I realized I’d missed a text from your dad. He said that they had stopped Pitocin because the monitors showed a concern for your heart rate. They planned to take a break and go to sleep, so I reluctantly went back to sleep too. However, at 2am I woke myself up again. This time I was covered in sweat, as if I’d taken a bath in it. Emotionally, I was unexplainably full of fear. I decided to take a shower and pray. I asked God what to think about what was happening. A thought passed through my mind that you have your cord around your neck. I began to pray over your safety specifically concerning that and I felt filled with faith. This made me confident the Lord was telling me to pray over your cord. I had already been praying for your birth to go beautifully and safely because I know your mom and dad worked so hard to give you the best. But that experience taught me how to trust even more that God was looking out for you too. It was not easy, but I was able to sleep a little more before the sun started to rise. At 6am I texted your Dad to say I was going to leave to come check on them shortly. I stopped at Starbucks on the way and picked up some much needed caffeine for us. As I waited in line, I got more text messages from your Dad. They were about to stop Pitocin because of your heart rate for the second time and Dr.Cobb was going to check for cervical progress in your mom. It was hard to hear. Since your water was already broken, I knew our options were already so limited in ways to get you to come quickly. If Pitocin was taken away too, a cesarean would be necessary. So this time around, I was going to think of everything I could to make sure it worked both for your mom’s body and for you. As the doula, I’m thinking of physical, mental, and spiritual variables. So the first thing I did was tell Amber we should pray. She said she had been doing so and that she also did a devotional. I was so proud of her! As we walked around the hospital preparing for the next Pitocin round, I also brought up the idea of praying and believing for miracles. I wanted her to be filled with as much faith as possible, and remove fear. When we got to the room, your mom took a shower and came out looking in high spirits. I put clary sage oil on her belly (an oil known to help start labor). I put some lavender oil in a cup of ice water to calm the room and to use on a wash cloth for later if she felt hot. At an earlier time, your mom and dad left me to talk to Dr.Cobb alone, at which point I told him that God told me that the cord was around your neck. (He probably thought I was crazy!) But he said that was an unlikely case based on the way the decelerations looked on the monitor. Knowing Dr.Cobb is very skilled and highly trusted in the community, I assumed he must be right and let those thoughts go. I also learned from your parents that the nurse they had last night was not someone they felt so connected with and they prayed for Tanya to come back….and she did! Not more than 15 minutes later, she was their nurse again! Tanya was such an angel! She was conservative on how fast she turned up Pitocin, only up-ing it at half the typical rate. She always spoke in whispers, respecting the hypnobirthing approach. And she even broke some rules to make your mom more comfortable! What a blessing! As we prepared to start Pitocin again, I considered why didn’t surges start on their own with the water broken for so long? I thought possibly you were not low enough to put pressure on her cervix. That would explain why Dr.Cobb had to reach far to get to your mom’s cervix. So I had your mom do a position called the “Walchers” to get you engaged in her pelvis. This was the first of the very uncomfortable things I asked her to do, but she willingly did it without one complaint! Also, to lower you into her pelvis I tried an acupressure technique on her shoulders. Then I tried one for dialation on her ankles. Deeply pressing on those pressure points are not so comfortable either. Then I let your mom’s body and you do the rest of the work. Before things got very intense, we spent time making lots of jokes. She ate some apples and almond butter, and also we watched your parent’s adorable wedding video. Their love is truly a RARE one! That is surely a lot of what gave your mom the strength she needed. Your mom was so brave as she let the intensity build. She trusted the process and listened to her body! She accepted each new level of discomfort and took it on with acceptance. She was still smiling and making lots of jokes for much of time! But she also was really good at letting us know what she needed to help her be as comfortable as possible. Your Dad didn’t miss a single beat. He was calm and ready to help her over and over again, (even though he only slept two hours the night before!). He spent a lot of time pushing on her hips with all his might. Your grandma was there too, and her peaceful demeanor reminded us all to be at peace. As time went on I found myself 100% confident that Pitocin was working for you and her, and she would be pushing you out that day. You were ready, her body was ready, she was ready mentally, and your dad and I of course couldn’t wait to get the show on the road. Because she complained of lower back pain prior to labor as well as during, I had her do some lunges on each side to see if that would help turn you into the perfect position. Pitocin was only up to 6ml/min. when I noticed she was progressing quickly. I prayed that this was truly progression, not just an overload of pain from the Pitocin (as that is it’s reputation). We had no idea where her cervix was at because we all knew not to check for safety’s sake. So we just had to continue to trust God. Your mom did this whole trusting the unseen thing better than any of us! And just think, she’s the one that had to do that WHILE feeling the discomfort of labor! But she just read her uplifting quotes, had your Dad read an encouraging message written by Joel Olstien, and hummed to worship songs (almost the entire time!). The next level of intensity arose and I witnessed your mom do something that brought me to tears. I suggested she imagine holding you, but she took it up a level. She held a pillow with your clothes lying over it imagining it was you. Holding you, kissing you, smelling you…it all got her through it. She loves you SO MUCH! I’m tearing up again as I write this. What a mother she was in that moment even before you were born! Many other comfort measures were a result of your mom just listening to what her body told her to do. She would spend a lot of time on her knees leaning onto either a chair or the bed. That did help the back pain for most of the time, until she was nearing the end of the process. Then the back pain seemed to become a consistent and ever increasing problem. She wanted a lot of counter pressure on her bottom, outer hips, lower back, and inner hips. And she also constantly wanted heat on those areas too. I couldn’t be sure that your position wasn’t ideal, but I also dreaded the thought of her working this hard only to get to an even more difficult pushing experience with a posterior baby. I offered some positions to try to insure an efficient decent, but at this point asking your mom to move at all was understandably aggravating. She had long passed the talking and joking phase. Your aunt Heather had arrived earlier in this stage and she whispered her love and encouragement to your mom. There was one particular bathroom break I went with her to and noticed she had lost her bloody show. Now I was REALLY excited because that was a good sign she was enduring so much for good reason (progress). Shortly after that, at about 3:30pm on March 4th, your mom started to describe the beginning of “second stage” or the pushing –phase. I went out to tell the nurse and she came in ready to check your mom. Surprisingly, your mom only felt lots of pressure in her bottom but not the urge to push. Because I couldn’t be sure of how dialated she was, I was still considering baby-to-pelvis positional issues. My concerns grew as I noticed her surges started to space out and more time went on. It was more time that my experience would tell me appropriate for a mom to feel the urge to push if she was fully dialated and feeling all that bottom-pressure. Thankfully, your mom asked to get checked and that gave us the answer we needed. Tanya only told me what the vaginal exam revealed. I learned that your mom only had a portion of cervix left on the right side but it was thick. No wonder! I thought, that’s why she’s complaining about her bottom but not pushing! It all made sense now because she had complained of more pain on her left side. So my assumption is that your head was very transverse, meaning you were facing straight to your mom’s right side. All the heaviness of the back of your head on the left side made her left side hurt more and made her cervix unpressured on the right side. I asked if she could push through that last portion of cervix, and Tanya said no, not unless it was on the top area. So I made an executive decision (which us doulas really try not to do because we want all that power to stay within the parents!). But in this special case I decided to tell your mom what was going on and what to do next. I told her my suggestion was to get out of the bed and do some right-sided lunges and get rid of that last bit of cervix. Your dad was a good convincer when he added, “you can do this Amber, you can do a few lunges for your baby girl!” We helped her up and she gave it everything she had! After that she was in the bathroom again complaining of needing to do a #2 but not being able to. I went in the bathroom with her again and watched her push and push and push to try and relieve that feeling of needing to poop so bad. But obviously with the knowledge that her cervix could very well be completely gone now, I wondered if I’d end up catching you there in the toilet! That time felt like it went on forever, just me and your mom sitting there with her pushing. I finally said, “Amber, hunny, you’re not supposed to be pushing so much yet.” She was pooping too however, so it was a very confusing situation. I looked back at the nurse to get her attention. She came in and checked your mom, and she felt your head right there! She asked your mom to get back in the bed quickly. This was at about 5pm. On your mom went; so composed and so serious. She knew this was go time and she was taking it on like a champion. And she was really doing it at this point all on her own! We all got so excited it was so hard to stay quiet, but your mom really needed it quiet because she needed every bit of mental focus to do what she was doing so well. The nurse had your dad look and see you there on your way out. My goodness, was he overjoyed! It took a long time for Dr.Cobb to make it to the room, but that was okay. Pushing was going so well, quickly but not too quickly. I whispered some encouragement to your mom. Tried to help her breathe and push when it was time, and how to breathe and not push when they said not to. At about 5:32pm your head was on its way out and time stood still. Dr.Cobb asked your Dad to hold off catching you so he could…..get this….remove your cord from around your neck TWO TIMES! WOW! But out you came safely anyways at 5:34pm. Your Dad held you as your mom flipped over. Before she could see you, you let out your first cry. Your mom reacted with love, “ohhh!” You were in her arms only a second later. And love filled the room to the ceiling! Oh how we all cried out of pure happiness that you were here and safe. At one point, I saw your dad on the floor next to your mom in her bed. He had is head down and he was weeping. I’m sure he was full of gratitude and so proud. That journey was so miraculous for so many reasons! Your safety was potentially at risk for multiple reasons, but a vaginal birth was still attainable. Your Mom and Dad’s ability to remain faithful even with a quick and drastic change in plans. The fact that God answered prayers and really showed up in protection over you and your mom. The love your parents share for each other empowering them to press on. And especially, your mother’s inner WARRIOR she found as she kicked Pitocin’s butt! A first time mom having an un-medicated birth while on Pitocin for nearly ten hours (the 3rd time) is almost unheard of. OH, I could not be more proud of her! Thank you so much little Audrey for teaching us how to trust. We need love, we need preparation, and we need God’s presence to take on miracles like that. And you, little Audrey will continue to teach your family how much of a miracle you truly are. I am blessed to have met you so soon in your anointed life. Thank you to your whole family for allowing me to be a part. Sincerely, Karen Sousa, your forever doula Philippians 4:4-8 4 Rejoice in the Lord always. I will say it again: Rejoice! 5 Let your gentleness be evident to all. The Lord is near. 6 Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. 7 And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus. 8 Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable—if anything is excellent or praiseworthy—think about such things. I would like to address two cultural norms in this area that could use some adjustment. I hope that my observations and criticisms are received with the right heart. I understand that we make decisions as parents often thinking it's from our gut, when in reality, we are doing things a certain way because it's all we know. We have a lot of growth to do when it comes to evidence based maternity care in this area. I can only hope to be a small part of the growth I hope to see. The first thing I hope to address is breastfeeding related; it's early pacifier use. Since moving to Temecula, I have made a lot of connections on social media with the mothers in the area. Almost every time I see a picture of a newborn posted, there is a binky in their mouth. Are you wondering why I would take the time to address something so seemingly minimal? I get it. It's just a binky, what harm could it do? From a Lactation Professional's stand point here's why seeing that erks me. Newborn babies have to learn to eat. They have many different natural instincts to help them along, but one of the biggest learning curves for them is often proper latch. They need a wide mouth and lots of jaw-movement to achieve milk transfer. This is work compared to the motion of sucking they use with anything else you put in their mouth. "But they'll use me as a pacifier otherwise!" - another common misconception. No, babies don't know how to use someone as a pacifier because they don't know what a pacifier is. They have a biological reason to suck that is not connected to hunger! It is because that motion actually helps them pass that tough meconium stool! In addition to that, YOU need them to be at the breast as often as possible anyways. The amount of ample mature milk that you will supply will be defined by how often the baby is breastfeeding on you during that first few days. If you want to be sure that you're making a sufficient supply, you should be having baby using you as a pacifier, so to speak. The more often they are sucking on something in a more shallow latch than what's required of them on the breast, the more likely they are to struggle latching properly. So in reality, I'm not just coming down on early pacifier use, I'm even cautioning mothers to watch how often they put their finger in the baby's mouth! So when then? The ideal time to introduce a bottle or anything similar is after the baby is three weeks old. Experience teaches us that if they've spent at least the first three weeks exclusively on the breast, they're less likely to develop preferences to a lazier, shallow latch. And if you're worried about the other side of the coin; will baby ever take a bottle instead of just me? The answer is, introduce that bottle before they're six weeks old. So the perfect window is after three weeks and before six weeks. The second thing that I'd like to address is the lack of awareness for alternative prenatal and maternal care. There are at least five midwives in this area who are ready and willing to help women. Home birth and birth centers are the more evidence-based option for low risk women. Maternal care by a midwife is proven to lower intervention rates. Intervention rates that will increase the likelihood for additional interventions. Ironically, if we lived here less than 100 years ago, the hospital would be the alternative to the norm. I'm always hearing about how people choose a particular hospital in the area because of the NICU. Unfortunately, I am sure most women have no idea that the need for a NICU is increased by hospital interventions, like inductions, Pitocin, cytotec, cesareans, etc... I think moms and Dad's need a refocus. Having a baby in the NICU is not actually a good thing! Hello. So lets do what we can do to prevent that in the first place. But what if something goes wrong? Here's the thing about midwives that most people do not know.... They come with all the same skills and tools as an OB apart from the Operating Room, PLUS more. They actually know how to support women on a psychological level, the place that determines the progression and success of our birth more than anything else. They know how to resolve issues by addressing the root causing, instead of relying on the convenience of a C-section. They bring oxygen with them, and various medications for safety. They have years and years more training and experience with birth than an EMT, who is also some how qualified to deliver a baby. In fact, did you know that an EMT does not carry the drugs you would need to properly stop postpartum hemorrhage, but a midwife does?! So, how about we take back our births instead of handing them over to someone else. How about we research the kind of care that is going to allow us to do that. It's not about natural birth, I'ts about physiologically respected birth. It's about informed consent. It's about expectant management. It's about YOU and your partner and your baby. It's hard to know what you want when you haven't figured out how to take control of what belongs to you. So, Riverside County, Inland Empire, Temecula Valley and surrounding communities, let's learn how to do that. It's time to get educated, learn about your options, create your supportive birth team, and take back your births! -Karen Sousa, CD(DONA), CLEC, CHBE owner of Temecula HypnoBirthing |
Karen Brann
Birth Doula, Childbirth Educator, Lactation Educator/Counselor Archives
July 2019
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